Background: Alcohol withdrawal is a common disorder faced by hospitalists. The pharmacologic standard of care involves the use of benzodiazepines, administered either as fixed doses or with doses adjusted per patient symptoms. At our institution, the alcohol withdrawal protocol previously in place used an institution-specific scale to evaluate patient symptoms, and nurses had latitude within [...]

Background: Adverse drug events (ADEs) are responsible for up to 770,000 inpatient injuries and deaths annually in the United States, most of which are from prescribing errors. Electronic order sets are designed to improve quality by reducing care variability and increasing efficiency of order entry, but may also facilitate prescribing errors via automation bias. There [...]

Background: Several studies attest the effectiveness of physician order set, also known as Power Plan (PP) in standardizing patient care and improving outcomes. In general, PP use is suboptimal. We hypothesized that PP use in patients admitted with Chronic Obstructive Pulmonary Disease (COPD) assists in  standardization and appropriateness of inpatient management. Methods: We conducted a [...]

Background:  Children and Young Adults with Special Healthcare Needs (CSCHN), especially those with multiple organ systems involvement, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach and coordination among multi-disciplinary team members. Previous studies have demonstrated that homecare is a cost-effective measure [...]

Background: Alcohol use disorder (AUD) has a lifetime prevalence of 29% in the United States and prevalence is higher among military veterans. Discontinuation of alcohol use in patients with AUD presents a risk for alcohol withdrawal syndrome (AWS). A recent retrospective analysis of Veterans Health Administration (VHA) data estimated AWS occurred in 5.8% of inpatient [...]

Background: Over the past fifty years, remote cardiac monitoring (“telemetry”) has become routine for many patients admitted to the hospital. Telemetry has many clinical benefits and is recommended by the American Heart Association for a limited set of indications, but is often inappropriately used. Overutilization of telemetry can lead to unnecessary tests and procedures, may [...]

Background: In light of increasing healthcare costs, diagnostic stewardship is an important component of providing high-value healthcare. Order sets, a collection of orders aggregated in a single location for a given diagnosis, condition, or treatment, are designed to promote adherence to evidence-based practices and reduce variability in care—both known drivers of high-value care (Atlas SJ [...]

Background: Electronic medical records (EMR) often allow automated recurring orders of different components of hospital care, including lab tests, vital signs, and telemetry monitoring. However, as patients clinically stabilize during a hospital admission the frequency and intensity of these recurring orders may be unwarranted (1). Well-designed EMR order sets have shown potential to decrease inappropriate [...]

Background: Community acquired pneumonia (CAP) is a leading cause of hospitalization, economic burden and excess antibiotic use in the United States.1,2 Previously, a multidisciplinary group at University of Utah Health launched a clinical decision support triggered CAP pathway in 2017 that was associated with cost savings and decreased duration of antibiotics.3 Based on review of [...]